Abstract Prior to hurricanes Irma and Maria, which impacted the entire Puerto Rico (PR) population, Puerto Ricans were already at higher risk of many non-communicable diseases (NCD) compared to other U.S. citizens. These hurricanes may have had an additional detrimental impact on NCD risks and outcomes, which will be the focus of this proposal. Our objective is to evaluate risk and resiliency factors at individual, family, organizational, and community levels to inform interventions and policies to improve health and resilience, as well as preparedness, mitigation, and recovery. The proposed study will build on our San Juan Overweight Adults Study (SOALS NIH R01DE02011), which collected extensive data and specimens including blood pressure, oral glucose tolerance tests, and food frequency and other questionnaires prior to the hurricanes. SOALS recruited 1,351 participants, 40-65 year old at baseline; 1,026 of the participants completed the three-year follow-up exam. We aim to conduct an additional follow-up visit on 375 of these participants, 125 each from the San Juan, the surrounding metropolitan area (125), and other parts of P.R. including urban and rural areas. We will also select 125 diabetes patients residing in areas in the direct path of Maria, who were receiving care before and after the hurricanes from ?Corporacin de Servicios de Salud y Medicina Avanzada? (COSSMA), a Federally Qualified Health Center, with HbA1c and other pertinent pre- and post-hurricane data available in electronic medical records. The additional follow-up for the 500 SOALS and COSSMA participants will be started around a year after the hurricanes. In addition, new questionnaires will be administered to assess the impact of the hurricanes on food insecurity, access to healthy food and water sources, psychosocial factors, and resilience. We will compare prevalence/incidence of diabetes, hypertension, asthma, depression, and NCD risk/protective factors, such as adiposity, water source, diet and physical activity, psychosocial factors, and cortisol from hair to measure chronic stress, before and after the hurricanes. We will evaluate associations between resilience and NCD risk, as well as between water source and pre-diabetes/diabetes. Claims data from COSSMA patients and eligible SOALS participants with Medicaid coverage (Mi Salud) will be abstracted from 2016-2018 to assess utilization of medical services and prescription drugs, and to identify gaps in healthcare, disruption in coverage, and other changes due to the hurricanes. As a second aim, we will conduct key informant interviews with leaders from the healthcare, social services and emergency and disaster response organizations to identify strategies that were effective, and those that require improvement in light of potential future natural disasters. Finally, we will integrate the multi-domain, multi-disciplinary information from individuals and organizations, and help improve preparedness, response, and resiliency through dissemination of key results to inform interventions and policies. Results from this study could benefit a broad spectrum of public and private organizations, Puerto Rico and US Virgin Islands, and have national and global relevance.